This form takes 5 minutes to complete.
Lynsey Retzlaff Wellness New Therapy Client Pre-screen Form
Please follow these steps to inquire about becoming a new therapy client with Lynsey Retzlaff:
STEP 1: Complete this pre-screen intake form.
STEP 2: Check your email for approval or denial. The information you provide on this form helps to determine if you and I will be a good fit. I value your time and this form helps me streamline the process of getting you care - either with me or someone else! If approved, you will receive a link to schedule a free 15-min consultation call. If denied, you will receive an email with resources will be provided.
I will respond in 24-48 hours.
STEP 3: After the Consultation Call, you can request an Initial Assessment appointment. You will receive an email with all intake paperwork. This paperwork is required before the start of services.
FREQUENTLY ASKED QUESTIONS/POLICIES:
Please read carefully.
Who do you serve?
I serve ambitious and high-achieving women between ages 18-60.
Who can complete this form?
You must be 18 years or older to complete this form. If you are not over 18 years old, DO NOT continue. A parent or legal guardian must complete this form.
Do you accept insurance?
Not at this time. I can provide "Superbills" if you are eligible for out-of-network reimbursement.
What types of payments do you accept?Credit card/Health Spending Account (HSA) Card/Flexible Spending Account (FSA) Card. To review rates click
HERE.
Why do I need a credit card on file?
All clients are required to have a credit card on file for business purposes detailed in your intake paperwork. I will never misuse your card.
If paying out-of-pocket and your card is declined, you will have 48 hours to update it, and another session cannot be scheduled until the account is in good standing.
I look forward to speaking with you!
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DISCLAIMER: If you are having a medical or mental health emergency, please call 911. This page and website are not monitored 24/7. For crisis and community services, please visit our resources page HERE. Submitting this form is not an agreement or start to services.
